Introduction: Biologics to Treat Substance Use Disorders: Vaccines, Monoclonal Antibodies, and Enzymes

Abstract

Cocaine use and HIV infection in the United States are inextricably intertwined. Cocaine is a drug commonly injected by people who inject drugs (PWID) in the United States, and PWID are incontrovertibly at risk for HIV acquisition (Friedman et al. 1989). In addition, there are many other complex direct and indirect associations in different populations between cocaine use and HIV infection. Cocaine use is associated in various contexts with a greater number of recent and lifetime sexual partners, transactional sex (trading sex for drugs or money), poor adherence to protective measures and treatment programs, and concurrent use of other drugs. In addition, there is a neurobiological rationale for the connection between cocaine’s effects and sexual behavior that increases the risk of HIV acquisition, but sociological factors strongly shape drug use and health factors in humans (Friedman et al. 2009), highlighting the extreme complexity of the overlapping epidemiologic landscape of cocaine use and HIV infection in the United States. The recent availability of the first prototypes of HIV and cocaine vaccines raises the question of the impact of these biological/medicinal interventions on this complex landscape. Theoretically, a combination HIV and cocaine vaccine could profoundly synergize to reduce HIV spread in affected populations, but the reality of HIV and cocaine networks in these populations may predict a very different outcome. In this chapter, we review the status and potential of these medicinal interventions, discuss the concept of their use as a combination vaccine or immunotherapy, and engage the question of how they might impact specific US populations of cocaine users at various levels of risk for HIV infection.